Diabetes and Hypertension: The silent epidemic amongst Bengaluru’s invisible workforce

In the bustling city of Bengaluru, where gleaming tech parks rise above crowded streets, a silent epidemic thrives in the shadows—one that is beginning to impact the domestic helpers, street vendors, migrant labor and construction workers who keep the city running. Once thought of as diseases of affluence, diabetes and hypertension have become common even among India’s poorest urban communities, quietly destroying lives and livelihoods.

The latest National Family Health Survey conducted between 2019 and 2021 shows that even in the poorest urban households, 13–16% of adults have diabetes and nearly one in three has hypertension—rates almost as high as their wealthier counterparts.

Behind these numbers are real people, like Kanchan (name changed), our house help, whose husband was diagnosed with both conditions after months of fatigue, dizziness, and finally a cut on the foot that would not heal. His job as a shift manager in a local restaurant became harder to sustain, and the loss of income coupled with treatment costs weighed heavily on the family. Or Muniappa (name changed) a driver, who at 35 years is already on medication to control type 2 diabetes. Their struggles prompted me to look closer and write about it.

With guidance from Dr Ramesh, a leading local doctor and diabetes specialist, I conducted a diabetes and hypertension screening camp to better understand the scope of the problem in my own community in Ramagondanahalli, Bangalore. About 70 informal-sector workers showed up comprising equal number of women and men with an average age of only 47 years.

The mean blood sugar was 156 mg/dL, with 17% of participants showing dangerously high blood sugar levels (>200 mg/dL) 

• 50% of respondents had calculated Body Mass Index over 24.9 with 17% recording BMI over 30.

• The mean blood pressure was borderline high at 132/87 mmHg, and 40% met the criteria for hypertension (≥140/90 mmHg).

• 33% respondents had elevated systolic or diastolic hypertension despite having a BMI below 25. This reflects the prevalence of “skinny fat” where respondents appear lean but have a relatively high percent of body fat and lower muscle mass. 

• 1 in 5 respondents reported insufficient sleep of 5 hours or less every day reflecting the burden of working hours, the daily commute to work and time required for household chores  

• 12 respondents, 17% of the respondents admitted to consuming packaged/ processed foods. While this looks low it was not probed further in the camp. 

• Not surprisingly, given poor access to public transport, 81% respondents reported walking 30 minutes or more every day.

Yet what stood out most in the screening data was their self-reported stress, which was pervasive across the group. Participants were asked to rate their stress on a scale of 1 to 5. The average was 3.3, and nearly half rated their stress at the highest levels (4 or 5). Those with very high blood sugar had higher stress scores (3.5), although stress was common across all groups. In conversations during and after the screening, many cited long working hours, financial insecurity, unstable housing, family pressures, and job instability as contributing factors.

The insights from the camp are not isolated. While shadowing doctors at local clinics, I came across many patients who arrived undiagnosed, describing symptoms like fatigue, dizziness, and vision issues. I witnessed doctors treating severe cases, including a man with kidney failure and a woman with peripheral neuropathy that paralyzed one side of her body.
What I observed was how patients often normalized their symptoms, delaying care until complications became dangerous.

Recent research by Nishkant Singh et al. highlights the complexity of India’s diabetes and hypertension epidemic. Depending on diets, heredity and other environmental factors, some states show high diabetes but low hypertension and others the reverse. As Bengaluru is a magnet for workers from all over India, these patterns are extremely important to understand while devising treatment plans.

Looking at the study, it is very evident that both diabetes and hypertension are still on the rise -not only in the urban population, but also in the working population from rural places. It clearly shows the importance of screening such a population and making them aware of these conditions will help to treat and manage appropriately.

Dr R. K. Ramesh, R.K. Multispecialty Centre, Ramagondanahalli

Call to Action for Employers and Resident Welfare Associations (RWAs)

While much is already being done by government, NGO’s and private citizens to fight these diseases, I suggest three steps Employers and RWAs can easily take:

1. Raise Awareness: Bring attention to diabetes and hypertension within our homes and neighborhoods. Affordable testing devices are widely available, and many workers are willing to learn more about their health. It is easy to track blood sugar, blood pressure and basic health parameters.

2. Promote Healthy Diets and Lifestyles: While tasty and easily available, processed and salty foods pose a serious risk. In my study, 27% of participants added extra salt to meals. Working women in particular reported lacking the time to cook.

3. Organize Community Screenings: Host monthly or quarterly health camps for local office and domestic workers. Early detection and basic interventions can prevent many complications.

The silent epidemic is no longer confined to the affluent. It is present in the lives of those who build and maintain our offices, homes and cities. It is time we saw them, heard them, and acted.

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Neel Bindiganavile is a class 12 student at The International School, Bangalore. In this work he was guided by Dr. R. K. Ramesh, R.K. Multispeciality Centre, Ramagondanahalli.